Cannabis & End-of-Life Care

Improving Quality of Life


The Potential of Medical Cannabis to Provide More Comfort and Better Relief

Patients in Florida who are suffering from terminal conditions and have less than one year to live now have access to medical cannabis.

In June 2015, Florida passed the Right to Try Act, allowing patients with terminal conditions (i.e., those with less than twelve months to live) the ability to access experimental medications that were previously unavailable to them.  In March 2016, medical cannabis, containing any strength of active cannabinoids, was included in the Right to Try Act.  This expansion allows patients with terminal conditions access to an alternative therapy that may help with chronic pain, sleep improvement, appetite stimulation, anxiety relief, and other symptoms.

Right-to-Try

Florida House Bill 269: This 2015 bill creates the “Florida Right to Try Act,” which provides a framework in which an eligible patient with a terminal condition may access investigational drugs, biological products, and devices from the manufacturer. The Act also defines and requires written informed consent by the patient, the parent of a minor patient, a patient’s court-appointed guardian or the patient’s health care surrogate. Finally, the bill prohibits actions against a physician’s license based solely on his or her recommendation regarding access to or treatment with an investigational product under this Act.

  • A terminal condition is specifically defined under the Right to Try Act as a progressive disease or medical or surgical condition that causes significant functional impairment, is not considered by a treating physician to be reversible even with the administration of available treatment options currently approved by the United States Food and Drug Administration, and, without the administration of life-sustaining procedures, will result in death within one year after diagnosis if the condition runs its normal course.

Source: https://www.flsenate.gov/Sessi...

How Can Medical Cannabis Help in End-of-Life Care?

Medical cannabis can help provide relief from pain and other distressing symptoms that commonly occur in patients with terminal conditions nearing the end of their lives. In clinical studies across diverse patients and medical conditions, medical cannabis has demonstrated efficacy in controlling a variety of symptoms that are relevant in end-of-life care, including:

  • Pain relief

  • Sleep improvement

  • Appetite stimulation

  • Anxiety relief

  • Anti-depressant activity

These symptoms may adversely impact a patient’s quality of life. Ensuring the comfort of the patient during this end-of-life period is of utmost importance.

A Safer Alternative

Medical cannabis also has the potential to be safer and better tolerated than other therapeutic options, such as opioids or anti-anxiety agents that may negatively impact a patient’s ability to function or engage with others around them. Commonly-occurring adverse events of opioids, such as constipation and nausea, may take a significant toll on patients suffering from terminal conditions. Patients who are currently taking opioids for pain relief could potentially be treated with either medical cannabis alone or in combination with a lower dose of opioids. Clinical studies of medical cannabis are needed in patients with terminal conditions to better understand the efficacy, safety and tolerability, value, impact on quality of life, and comparative effectiveness of this therapeutic alternative in end-of-life care.

CHT Medical is committed to providing safe, reliable options for medical cannabis treatments. See what we have to offer:

Talk with your doctor or hospice care provider about whether medical cannabis is right for you or your loved one to relieve symptoms associated with terminal conditions.

Active Compounds in the Cannabis Plant

The Right to Try Act allows patients with terminal conditions access to medical cannabis that contains any strength of tetrahydrocannabinol (THC) and any combination of different cannabinoids and other active compounds. The presence of clinically-significant levels of THC greatly expands the potential benefits of medical cannabis in managing symptoms at the end of life, as plant-derived products have the entire range of natural cannabinoids acting in concert to produce their therapeutic effects.

Different medicinal strains of cannabis have different amounts of therapeutic cannabinoids. Tetrahydrocannabinol (THC) is the most studied active cannabinoid derived from the Cannabis plant. THC has a demonstrated ability to reduce pain, spasticity, and nausea and to stimulate the appetite. THC also has psychotropic effects including euphoria, relaxation, heightened sensory perception, and altered perception of time. Cannabidiol (CBD), another abundant and important active cannabinoid found in the Cannabis plant, has been shown to reduce inflammation, pain, spasticity, seizures, and nausea. Unlike THC, CBD does not appear to produce euphoria or intoxicating effects. Cannabinol (CBN) is the active cannabinoid that is responsible for the sleep-inducing or sedative effects of cannabis and may have neuroprotective effects. Both CBD and CBN modify the effects of THC and also have distinct effects of their own.

Access to Medical Cannabis Therapy


Qualifying patients with a terminal condition are eligible to receive medical cannabis, which contains the psychoactive ingredient THC. Information on how to qualify to receive medical cannabis can be found below:

Eligibility

Excerpted from the Office of Compassionate Use:

Patients diagnosed with terminal conditions are eligible to receive an order for medical cannabis, which contains the psychoactive ingredient THC. Florida law defines a terminal condition as a progressive disease or medical or surgical condition that causes significant functional impairment, is not considered by a treating physician to be reversible even with the administration of available treatment options currently approved by the United States Food and Drug Administration, and, without the administration of life-sustaining procedures, will result in death within one year after diagnosis if the condition runs its normal course. Section 381.986, Florida Statutes, as amended by Chapter 2016-123, Laws of

Florida, includes several requirements for a qualified patient to receive an order for medical cannabis:

1. First, patients must schedule a face-to-face consultation with a qualified physician who has undergone the training required to order cannabis for patients. You can find a complete list of qualified physicians here. Physicians may only order cannabis for a patient if he or she has treated them for the immediately preceding three months.

2. To qualify for medical cannabis, a patient must be diagnosed with a terminal condition that is attested to by his or her physician. That diagnosis must be confirmed by a second independent evaluation from a board-certified physician in an appropriate specialty for that condition. Finally, patients must have considered all other treatment options for the terminal condition currently approved by the United States Food and Drug Administration.

3. The physician must obtain written informed consent of the patient or the patient’s legal guardian to treat with medical cannabis that includes:

  • An explanation of the currently approved products and treatments for the patient’s terminal condition.

  • An attestation that the patient concurs with his or her physician in believing that all currently approved products and treatments are unlikely to prolong the patient’s life.

  • Identification of the specific investigational drug, biological product, or device that the patient is seeking to use.

  • A realistic description of the most likely outcomes of using the investigational drug, biological product, or device. The description shall include the possibility that new, unanticipated, different, or worse symptoms might result and death could be hastened by the proposed treatment. The description shall be based on the physician’s knowledge of the proposed treatment for the patient’s terminal condition.

  • A statement that the patient’s health plan or third-party administrator and physician are not obligated to pay for care or treatment consequent to the use of the investigational drug, biological product, or device unless required to do so by law or contract.

  • A statement that the patient’s eligibility for hospice care may be withdrawn if the patient begins treatment with the investigational drug, biological product, or device and that hospice care may be reinstated if the treatment ends and the patient meets hospice eligibility requirements.

  • A statement that the patient understands he or she is liable for all expenses consequent to the use of the investigational drug, biological product, or device and that liability extends to the patient’s estate, unless a contract between the patient and the manufacturer of the investigational drug, biological product, or device states otherwise.

Source: http://www.floridahealth.gov/p... (continued below)

To take the next steps towards pursuing medical cannabis treatment, please follow the link to additional patient information below:

Ordering and Picking Up Treatment

4. The physician enters the order of medical cannabis for the named patient in the Compassionate Use Registry and updates the registry to reflect the contents of the order. The physician must deactivate the patient’s registration when treatment is discontinued.

5. The physician maintains a patient treatment plan that includes the dose, route of administration, planned duration, and monitoring of the patient’s symptoms and other indicators of tolerance or reaction to the medical cannabis. The physician submits the patient treatment plan quarterly to the University of Florida College of Pharmacy for research on the safety and efficacy of medical cannabis on patients.

6. Finally, a patient may fill their order at a qualified dispensing organization. The dispensing organization will verify the identity of the patient or legal representative, as well as the order in the Compassionate Use Registry. A dispensing organization may not dispense more than a 45 day supply.

7. The use of medical cannabis does NOT include the following:

  • The possession, use or administration of medical cannabis by smoking.

  • The transfer of medical cannabis to a person other than the qualified patient for whom it was ordered.

  • The use of medical cannabis on any form of public transportation, in any public place, in a qualified patient’s place of employment, if restricted by his or her employer, in a state correctional institution, on the grounds of a preschool, primary school, or secondary school or any school bus or vehicle.

Source: http://www.floridahealth.gov/p...